Young women diagnosed with breast cancer often must delay pregnancy for years while they take hormone-blocking pills. A reassuring new study finds they can take a two-year break from these drugs to get pregnant without raising their short-term risk of cancer coming back.
Many women with two or three breast tumors can get by with lumpectomy surgery instead of having their whole breast removed, a new study suggests.
In recent years, more patients with multiple tumors have been identified, a result of more sensitive imaging techniques that can reveal tiny, once-hidden cancers. That means more patients are being diagnosed with multiple cancer sites in the same breast.
In the past, doctors would say these women needed mastectomies. Researchers wanted to know: Was this dogma still true?
They followed nearly 200 women with two or three tumors in one breast who had lumpectomies followed by radiation. The patients ranged in age from 40 to 87. To take part in the study, their tumors had to be less than 5 centimeters and separated by 2 to 3 centimeters of normal breast tissue.
After five years, just 3% saw cancer come back, similar to rates from previous lumpectomy studies in patients with only one tumor. The study, supported by the National Institutes of Health, was being discussed Friday at the San Antonio Breast Cancer Symposium.
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"This study caught my attention very quickly," said Dr. John Kiluk, a surgeon at Moffitt Cancer Center in Tampa, Florida, who was not involved in the research. "It is definitely a step forward for our field."
Lumpectomy's advantages include quicker recovery and, often, better cosmetic results.
A technician displays images of a mammogram scan on a computer screen Oct. 20, 2021, at a hospital in Odessa, Texas.
No surgery guidelines existed for these patients but some doctors already were offering lumpectomy as a choice, said Dr. Judy Boughey of Mayo Clinic, who led the research.
"This will make them more comfortable with that approach," Boughey said. "And I think it will also make patients ask their surgeon, 'OK, I have two sites of disease. Do I have to have a mastectomy? Or can you give me breast conservation?'"
The study did not randomly assign patients to lumpectomy or mastectomy. That would have yielded better data, but it would be nearly impossible to find women willing to be randomly assigned, Boughey said, making such an experiment impractical.
In the study, the women who had an MRI before surgery did the best, suggesting MRI scans may help surgeons be more thorough at removing cancer.
The study is part of a larger research movement aimed at avoiding overtreatment and unnecessary side effects by "right-sizing" cancer care, Boughey said.
"Do we have to throw the kitchen sink at everyone?" she asked. "Which patients need every single option that we have available and which will do just as well without having the kitchen sink thrown at them? Every single treatment has some kind of side effects."
States with the highest rates of breast and cervical cancer screenings
States with the highest rates of breast and cervical cancer screenings
As coronavirus cases rose in 2020 and overwhelmed the health care system, the number of patients seeking non-emergency treatments such as annual checkups and health screenings dropped. In April 2020, breast cancer screenings declined by 87% and cervical cancer screenings were down by 84% from the previous five-year averages, according to the Centers for Disease Control and Prevention. The pandemic not only took a toll on those who contracted COVID-19, but also exacerbated timely medical preventive treatment for those with other health conditions.
One study—published in the October 2021 issue of Preventive Medicine—examined the impact of COVID-19 on screenings from the first half of 2020; it confirmed the decline in both cervical and breast cancer screening across geography, various ethnic and racial groups, and rurality. Results correlated with the rapid increase of COVID-19 cases in spring 2020.
As recommended by the CDC, mammograms and Papanicolaou test screenings (also known as Pap smear tests) are vital tools in the fight against breast and cervical cancer. The guidelines recommended by the U.S. Preventive Services Task Force (USPSTF) advise that women between the ages of 50 and 74 have a mammogram every two years. Additionally, screening for cervical cancer is recommended every three years for women ages 21 to 29. The USPSTF advises a Pap test every three years and/or HPV testing every five years for women ages 30 to 65.
However, as awareness grows about the importance of these detection tools, one thing standing in the way of women getting their recommended screenings is access to quality care. Health disparities are a major public health concern and can hinder cancer screening and treatment. Patients who lack insurance, aren’t able to travel to doctor visits, and face language or cultural barriers often have worse health outcomes. To save lives and meet desired screening targets, these gaps must be addressed to ensure quality health care access.
Citing data from the CDC, HealthMatch looked at screening rates for breast and cervical cancers across every state and outlined the role of screenings in detecting early-stage cancers and improving survival outcomes. CDC reports this screening data is specific to ‘women’ but does not detail whether the data categorizes people based on their gender identity or their sex assigned at birth.
Ten states are meeting mammography screening goals
Healthy People 2020 was a national public health goal to increase the percentage of women who receive breast cancer screening by 2020. Women between the ages of 50 and 74 were advised to have a mammogram every two years. According to State Cancer Profiles, 78.3% of women were screened in the U.S. by 2020, a median percentage that fell short of the target goal of 81.1%.
There were, however, 10 states and territories that did meet the target goal (>81.1%): Maryland, Connecticut, Iowa, New York, Louisiana, Maine, Puerto Rico, Hawaii, Rhode Island, and Massachusetts.
Healthy People 2030 continues to aim towards percentage point improvement. The target goal is to have 77.1% of women screened for breast cancer in all states in this decade.
